| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,725 |
9,173 |
$386K |
| D0210 |
Intraoral - complete series of radiographic images |
3,201 |
3,058 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,511 |
2,072 |
$176K |
| D1110 |
Prophylaxis - adult |
6,807 |
6,438 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,094 |
2,965 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,155 |
702 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
482 |
353 |
$46K |
| D1351 |
Sealant - per tooth |
5,394 |
1,726 |
$42K |
| D1120 |
Prophylaxis - child |
5,793 |
5,487 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
848 |
645 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,364 |
11,683 |
$24K |
| D9999 |
Unspecified adjunctive procedure, by report |
452 |
426 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
35 |
31 |
$11K |
| D0274 |
Bitewings - four radiographic images |
6,099 |
5,764 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
789 |
730 |
$8K |
| D2950 |
|
110 |
76 |
$7K |
| D1330 |
|
12,847 |
12,158 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,610 |
3,962 |
$5K |
| D2394 |
|
48 |
40 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
5,176 |
4,893 |
$4K |
| D0272 |
Bitewings - two radiographic images |
2,096 |
1,999 |
$3K |
| D1999 |
|
27 |
27 |
$1K |
| D9310 |
|
25 |
25 |
$789.85 |
| D0999 |
Unspecified diagnostic procedure, by report |
18 |
18 |
$360.00 |
| D0601 |
|
1,371 |
1,359 |
$298.00 |
| D0330 |
Panoramic radiographic image |
102 |
102 |
$130.82 |
| D0602 |
|
150 |
150 |
$50.00 |
| D9986 |
|
78 |
74 |
$0.00 |
| D0603 |
|
81 |
80 |
$0.00 |